目的 本文主要研究能谱CT定量分析对霍奇金淋巴瘤的纵隔肿大淋巴结诊断价值.方法 选取2020年1月至2023年1月,于我院就诊霍奇金淋巴瘤患者100例,对其行能谱CT定量分析,评估其对霍奇金淋巴瘤的纵隔肿大淋巴结诊断价值.结果 100例霍奇金淋巴瘤患者,60例为纵隔肿大淋巴结,占比60％,其中单发淋巴结肿大13例,包括血管前间隙9例,气管旁4例,多发淋巴结肿大47例,血管前、气管旁、主动脉旁、肺门等处均有分布;能谱CT检出纵隔肿大淋巴结56例,占比56％,准确率为93.33％(56/60),其中单发淋巴结肿大10例,多发淋巴结肿大46例;56例纵隔肿大淋巴结患者,淋巴结边缘形态多为圆形或椭圆形,边界较为清晰,其中未出现明显钙化及坏死情况,41例患者出现淋巴结融合,占比73.21％,27例患者邻近组织受压改变,占比48.21％;增强扫描结果显示,39例患者为轻-中度强化,占比69.64％,43例患者为渐进性强化,占比76.79％;纵隔肿大淋巴结动脉期及静脉期的NIC分别为0.15±0.01、0.43±0.06,NWC分别为1.06±0.09、1.11±0.10,Eff-Z分别为7.24±0.86、6.87±0.75,λHU分别为0.78±0.06、1.22±0.14;纵隔肿大淋巴结的能量曲线及λHU、IC、WC、均呈正相关(P＜0.05),且动脉期及静脉期的平均能谱曲线CT值随kV的增加而减小;能谱CT检测霍奇金淋巴瘤纵隔肿大淋巴结的灵敏度为80.54％,特异度为74.21％,AUC为0.781.结论 能谱CT定量分析具有较高的检出率,可有成效检测出患者纵隔肿大淋巴结,具有诊断价值.

目的 探讨能谱CT对结节病和霍奇金淋巴瘤的纵隔肿大淋巴结鉴别诊断价值.方法 回顾性分析于2018年1月-2021年3月在唐山市人民医院经穿刺活检病理证实的21例结节病和39例霍奇金淋巴瘤患者,所有患者均行胸部双期能谱CT增强扫描,测量并计算、分析动脉期和静脉期中纵隔肿大淋巴结的单能量CT值、标准化碘浓度值(NICs)、能谱曲线斜率(λHU)和受试者工作特征曲线(ROC)和差异;同时比较二组患者纵隔肿大淋巴结的解剖分布和形态学特征.结果 结节病组动脉期的40～100 keV单能量CT值和静脉期的40～50 kev单能量CT值均高于霍奇金淋巴瘤组,差异有统计学意义(P＜0.05);结节病组动脉期的NICs和动脉期、静脉期的λHU均高于霍奇金淋巴瘤组,差异有统计学意义(P＜0.05).ROC曲线分析显示动脉期40keV单能量CT值鉴别诊断结节病与霍奇金淋巴瘤的敏感性(71.4％)和特异性(100％)最高.二组病变纵隔肿大淋巴结的解剖分布、融合、钙化、压迫、强化方式及强化程度均有统计学意义(P＜0.05).结论 能谱CT成像对霍奇金淋巴瘤和结节病的诊断鉴别具有重要的价值.

Objective To compare the differences of energy spectrum CT between small cell lung cancer(SCLC)with mediastinal lymph node metastasis and mediastinal sarcoidosis.Methods Twenty-five SCLC patients with mediastinal lymph node metastasis(SCLC group)and 26 patients with mediastinal sarcoidosis(sarcoidosis group)confirmed by bronchoscopy and biopsy in Tangshan People's Hospital from January 2018 to June 2019 were selected as the research objects.The CT value,iodine concentration,water concentration and energy spectrum curve slope under different single energy levels were compared between SCLC group and sarcoidosis group.Results The single-energy CT values of 40-80 keV segments in the arterial phase of the SCLC group were significantly higher than those in the sarcoidosis group(all P <0.05).The single-energy CT values of 90-140 keV segments were not significantly different from those in the sarcoidosis group(all P >0.05).The single-energy CT values of 40-90 keV segments in venous phase of the SCLC group were significantly higher than those of the sarcoidosis group(all P <0.05),and the single-energy CT values of 100-140 keV segments were not significantly different from those of the sarcoidosis group(all P >0.05).The concentrations of iodine in the arterial phase and venous phase of the SCLC group were(11.56±4.06)μg/cm 3 and(13.39±0.87)μg/cm 3,respectively,which were significantly higher than those [(4.43±3.85)μg/cm 3,t=11.564,P=0.026;(7.23±2.71)μg/cm 3,t=13.653,P=0.021] in the sarcoidosis group.The concentrations of water in the arterial and venous phases of the SCLC group were(1040.67±5.62)mg/cm 3 and(1035.23±8.57)mg/cm 3,respectively,which showed no statistically significant difference compared with those [(1028.87±6.94)mg/cm 3,t=3.155,P=1.861;(1021.53±4.68)mg/cm 3,t=3.265,P=1.687] in the sarcoidosis group.The slopes of energy spectrum curve at 40-70 keV,70-100 keV and 100-140 keV in venous phase of the SCLC group were significantly higher than those of the sarcoidosis group(all P <0.05),whereas they showed no significant difference between the two groups in arterial phase(all P >0.05).Conclusion The differences between SCLC with mediastinal lymph node metastasis and mediastinal sarcoidosis can be shown on the single-energy CT values of 40-80 keV in arterial phase and 40-90 keV in venous phase,iodine concentrations in arterial phase and venous phase,and the slope of energy spectrum curve in venous phase.

目的 分析鉴别原发性纵隔神经内分泌癌(mediastinal neuroendocrine carcinoma,MNC)和胸腺癌能谱CT成像的定量参数特征性改变.方法 回顾性分析经唐山市人民医院穿刺活检病理证实的13例原发性MNC和27例胸腺癌患者,所有患者均行双期能谱CT增强扫描,测量并计算病变于动脉期、静脉期的单能量CT值、碘基物质值、ROC曲线,对二组患者行定量、定性综合全面分析.结果 原发性MNC于动脉期40～70 keV的单能量CT值和碘基值均高于胸腺癌,差异有统计学意义(P＜0.05);胸腺癌于静脉期40keV单能量CT值低于原发性MNC,差异有统计学意义(P＜0.05).ROC曲线分析显示动脉期50keV单能量CT值对鉴别原发性MNC与胸腺癌有较高的ROC曲线下面积(0.889)、灵敏度(83.3％)与特异度(85.7％).二组病变的边缘、形态、坏死情况、双期强化情况、大血管、心包和胸膜侵袭方面差异均无统计学意义(均P＞0.05).结论 能谱CT成像对原发性MNC与胸腺癌鉴别诊断有一定的价值,而单纯形态学和增强扫描鉴别诊断意义不大.

Objective To investigate the differences in energy spectrum CT findings between anterior mediastinal lymphoma and thymic carcinoma. Methods Twenty-two cases of anterior mediastinal lymphoma and 28 cases of thymic carcinoma confirmed by biopsy in Tangshan People's Hospital were selected.The CT values and changes of iodine content and water content in lesion sites were measured by energy spectrum analysis software.The differences between anterior mediastinal lymphoma and thymic carcinoma were compared. Results The single-energy CT value of 40-80 keV in thymus carcinoma was higher than that in anterior mediastinal lymphoma(P=0.001,P=0.037,P=0.042,P=0.034,P=0.002;P=0.016,P=0.013,P=0.018,P=0.024,P=0.012).The difference in the single-energy CT value of 90-110 keV between anterior mediastinal lymphoma and thymic carcinoma showed no statistical significance(all P>0.05).The concentrations of water in the arterial and venous stages of thymic carcinoma were significantly lower than those in the anterior mediastinal lymphoma(P=0.030,P=0.037),whereas the iodine concentrations were significantly higher(P=0.026,P=0.000). Conclusion Anterior mediastinal lymphoma and thymic carcinoma have remarkably different 40-80 keV single energy CT value and iodine concentration in arterial and venous phases,which may be helpful for the differential diagnosis of these two malignancies.

目的 分析鉴别低危胸腺瘤和高危胸腺瘤能谱CT成像的定量参数特征性改变.方法 回顾性分析2017年5月-2019年12月经病理证实的23例低危胸腺瘤和17例高危胸腺瘤患者,术前均行双期能谱CT增强扫描,通过获得不同单能量下的CT值和碘(水)浓度值对其进行定量分析,并对其形态学进行定性分析.结果 在动脉期,低危胸腺瘤40～70 keV单能量CT值和碘浓度值均低于高危胸腺瘤,差异均有统计学意义(均P＜0.05);在静脉期,高危胸腺瘤40～100 keV单能量CT值和碘基值均高于低危胸腺瘤,差异均有统计学意义(均P＜0.05);双期扫描中,低危和高危胸腺瘤水基值差异均无统计学意义(均P＞0.05).ROC曲线分析显示静脉期40 keV下CT值对鉴别低危胸腺瘤与高危胸腺瘤有较高的灵敏度(75.4％)与特异度(66.7％).二组病变的边缘、形态、钙化情况、大血管、心包和胸膜侵袭方面差异均有统计学意义(均P＜0.05),高危胸腺瘤均高于低危胸腺瘤.结论 能谱CT成像对低危和高危胸腺瘤均有一定的鉴别诊断价值,对临床有指导意义.

Objective To investigate the imaging features of kidney and perirenal space in hematologic diseases patients with acute kidney injury (AKI). Methods Thirty-two patients in Tangshan People′s Hospital and Leting Country Hospital were selected from January 2012 to December 2016, and data on the abdomen imaging were retrospective analysed. Of them, 2 patients were undifferentiated acute myeloid leukemia, 3 cases were acute promyelocytic leukemia, 2 cases were primary macroglobulinaemia, 4 cases were polycythemia vera, 17 cases were genepal lymphadenomatosis of bones, 2 cases were Pomes, and 2 cases were reactive mononucleosis. All the patients were plain scanned by CT and MR without enhancement scanning, in order to avoid aggravating the burden of kidney and prevent the occurrence of contrast agent induced nephropathy. Results Thirty-two cases were all in accordance with the AKI diagnostic criteria and had abnormal changes in the kidney and perirenal space. Imaging findings of AKI showed that the size of kidney was bigger, MSCT showed the density of kidney was lower. T1WI showed renal parenchymal signal reduced. T2WI showed renal parenchymal signal increased. STIR showed sequential parenchymal signal enhanced. MSCT and MR showed the bridging septate and fascia thicken and small effusion around the perirenal space. Conclusions There are abnormal imaging changes in kidney and perirenal space in AKI patients. By analyzing abnormal imaging findings in kidney and perirenal space, radiology doctors should alert clinicians to the occurrence of AKI. Key words: Hematologic diseases; Acute kidney injury; Interrenal gland; Tomography, X-ray computer

血液系统疾病在临床为常见病、多发病,常并发肾脏损害,部分患者往往因急性肾功能衰竭或急、慢性肾脏损害为首诊入院治疗.但是通过医学影像分析血液病患者肾脏以及肾周间隙异常改变或者以肾脏和肾周间隙异常改变分析其对血液系统疾病诊断价值的研究尚未见公开报道.本文通过多层螺旋CT(MSCT)和高场强磁共振(MR)分析血液系统疾病患者在肾脏以及肾周间隙的异常影像学改变,观察血液系统疾病肾脏损害的影像学表现,总结血液系统疾病肾脏以及肾周间隙的影像学特征;反之,通过对肾脏以及肾周间隙影像学异常改变的观察和分析,影像科医生应该提示临床医生警惕血液方面疾病的可能性以及该血液系统疾病在肾脏方面所造成的损害.

Objective To analyze the occurrence and development of the unilateral occult renal failure so as to improve the clinical physician' s understanding of the unilateral occult renal failure as well as to make early diagnosis and treatment, thereby reducing the occurrence of this disorder. Methods Fifty patients with the unilateral acute renal renal failure were collected. All of these patients were postrenal renal failure and were followed up for a period from 6 months to 6 years. All patients underwent MSCT scan, with full clinical data. All cases were subjected to the conservative treatment, except one for surgery. Of those fifty patients, 27 were unilateral ureteral calculi, 6 were unilateral UPJO, 3 were the inferior vena cava ureter, 4 were endometrial car-cinoma postoperative metastasis involved in the ureter, 7 were ovarian cancer postoperative metastasis to the pelvic invaded in the same side ureter, and 3 were bladder cancer involving the side ureter. The laboratory biochemical routine inspection data, clinical data, the final diagnostic information, and differential diagnostic information were collected from all patients. Results MSCT showed that there 50 cases (100%) of the unilateral and occult acute renal failure after single renal obstruction. All cases were not involved the acute renal failure. Following up for 6 months to 6 years on those 50 patients with MSCT, we found that 34 renal atrophy in the affected side and that the laboratory biochemical routine inspection materials were normal. Conclusion The unilat-eral and occult renal failure will develop to the chronic stealthiness kidney failure, renal atrophy and the lost of kidney function if this disorder is not treated timely.

胰腺脂肪浸润是指在胰腺外分泌腺体的组织间质中有脂肪细胞出现，导致胰腺酶释放减少，胰腺外分泌功能下降。目前临床上用于诊断胰腺脂肪浸润的手段多为影像学检查，包括腹部超声、CT和磁共振成像（MRI）。CT 检查对脂肪组织的敏感性和特异性都很强，而且脂肪组织的 CT 值为负值，极具有特征性。因此CT 是诊断胰腺脂肪浸润最常用有效的检查方法。本研究旨在通过对胰腺脂肪浸润CT 表现以及其与高代谢综合征的关联性进行研究分析，为临床早期诊断、早期治疗以及预防提供可靠的依据。现报告如下。

胰腺脂肪浸润，又称胰腺脂肪替代、胰腺脂肪增多症等，该病在欧美等发达国家发病率高于发展中国家，各年龄段均可发病［1］。其早期常无明显临床症状，而中晚期腺体因大部分被脂肪组织替代，胰腺酶生成减少，引起胰腺外分泌功能障碍。胰岛素抵抗（insulin resistance ，IR ）是指正常量的胰岛素起不到正常的降低血糖的作用，是糖尿病、高血脂、高血压、肥胖等多种代谢性疾病的共同发病基础［2］。胰岛素抵抗和胰岛B细胞功能障碍易导致代谢综合征和2型糖尿病。胰腺脂肪浸润常与IR相伴发生。目前对于胰腺脂肪浸润国内外尚无统一的诊断标准。而随着影像学技术的发展，CT 在胰腺疾病的诊断中表现出明显优势，根据CT 表现结合患者临床特点及实验室检查等，可提高诊断的准确率。本研究采用无创CT 扫描评估研究对象胰腺脂肪浸润情况，分析胰腺脂肪浸润与IR的关系，为有效降低IR及2型糖尿病（T2DM ）的发生提供新的方法。

Objective To identify the key CT features and differential characteristics of carcinomatous cavi-ty of lung and other cavities, and to improve the diagnosis rate of the cavities. Methods Eighty-one patients of pul-monary diseases with cavities in our hospital were selected and retrospectively analyzed. The site, size, content, thick-ness and other indexes of cavity were analyzed. Results In the 81 patients, the rate of cavity in the center of lesion for pulmonary carcinoma, tuberculosis, pulmonary abscess, caseous pneumonia, pulmonary fungal infection and pul-monary cyst were 23.8%(10/42), 73.6%(14/19), 25%(2/8), 20%(1/5), 100%(5/5) and 50%(1/2), respectively. The rate of cavity not in the center of lesion for pulmonary carcinoma, tuberculosis were 76.2%and 26.4%, respectively, and there was a significant difference (P<0.05). The rate of cavity in the upper lobe was the highest for caseous pneu-monia (80%), And the rate in the lower lobe were 69.0%and 12.5%for pulmonary carcinoma and pulmonary abscess, respectively, with statistically significant difference (P<0.05). In terms of average diameter of cavity, there was signifi-cant difference between pulmonary carcinoma and caseous pneumonia (P<0.05), but not between pulmonary carcino-ma and other pulmonary diseases (P>0.05). For the amplitude of CT, significant differences were found between pul-monary carcinoma and pulmonary abscess, pulmonary carcinoma and pulmonary fungal infection (P<0.05), but not be-tween pulmonary carcinoma and other pulmonary diseases (P>0.05). The average wall thickness of cavity was relative-ly high in pulmonary carcinoma, pulmonary tuberculosis and pulmonary abscess, with no statistically significant differ-ence between any two of the three (P>0.05). Conclusion The site, wall thickness and shape of the pulmonary cavity show great significance in the differential diagnosis of carcinomatous cavity and other cavities.

目的 探讨胰腺实性假乳头状瘤(SPN)的多层螺旋CT特征性表现,提高其术前诊断准确率.方法 回顾性分析2007年1月至2012年1月经术后病理证实的8例SPN的术前螺旋CT平扫和多期动态增强扫描的CT征象.结果 8例病灶均为单发;7例为类圆形,1例呈分叶状;位于胰腺头颈部3例,胰体尾部5例;均表现为胰腺囊、实性肿块;3例肿块内见钙化;增强后肿瘤实性部分及包膜呈渐进性、中度强化,囊变、坏死部分不强化;8例患者胰管均未扩张.实性部分CT平扫呈稍低或等密度,三期增强扫描所有病灶实性部分动脉期呈周边轻中度强化,门脉期和延迟期呈渐进性强化略高于动脉期,但强化程度均略低于正常胰腺组织,囊性部分平扫及增强均呈低密度.结论 SPN的多层螺旋CT检查具有一定的影像学特点,即瘤体多为单发,位置以胰腺组织的尾部多见,瘤体内组织以囊性与实质性按一定比例相混合的形态为主,CT密度值不均,瘤体界限清楚,胰腺管一般不扩张等,这些特点可作为术前对于SPN诊断的参考.

目的：观察肾癌患者肿瘤螺旋CT图像特征与病理征象的关系。方法136例肾癌患者，术前行螺旋CT检查，并将其CT图像特征与病理征象结果进行比较，探讨两者的关系。结果病理征象中假包膜是否完整、瘤内是否出血坏死与螺旋CT图像特征中瘤体是否＞3 cm、有无中心坏死不强化区、有无瘤周围环状低密度影、皮髓期肿瘤密度是否大于肾实质有关，病理征象中细胞核的分级与螺旋CT图像特征中瘤体是否＞3 cm、有无中心坏死不强化区、有无瘤周围环状低密度影有关（P均＜0．05）。结论肾癌患者肿瘤螺旋CT图像特征中瘤体是否＞3 cm、有无中心坏死不强化区、有无瘤周围环状低密度影与病理征象中是否有假包膜、肿瘤内有无出血坏死、细胞核分级的高低关系密切。

在孤立性肺结节的CT鉴别诊断中,形态学表现有重要的作用.同时,部分周围型肺癌患者开展的螺旋CT增强扫描动脉期图像上,可见到病灶内或周边纠集的异常血管影,被称为肿瘤血管成像.为探讨肿瘤血管成像的病理诊断基础,结合CT肿瘤血管成像的特点,进一步加以病理研究分析,从而分析肿瘤血管成像对周围型肺癌的诊断和鉴别诊断中的意义和应用价值.

目的 探讨多层螺旋CT(MSCT)扫描在进展期胃癌患者术前化疗疗效评价中的应用,找出进展期胃癌术前化疗疗效评价的最佳指标.方法 收集2012年1月至2013年12月确诊的胃癌患者129例,进行多层螺旋CT增强扫描,影像学评估为T3、T4期,化疗结束后2周内再行多层螺旋CT增强扫描评估,应用RECIST 1.1标准对化疗疗效进行评价,与RECIST疗效评价进行关联性分析.结果 化疗后平均肿瘤密度、肿瘤体积肿瘤厚度较化疗前均减小(P＜0.05或P＜0.01),化疗有效组肿瘤密度减小率、体积减小率均高于化疗无效组(P＜0.05或P＜0.01),肿瘤厚度减小率两组比较无统计学差异(P＞0.05).CT肿瘤体积减小率与RECIST疗效评价成正相关(rs =0.57,P=0.001).化疗前后肿瘤体积减小率ROC曲线下面积[0.907(95％ CI:0.784 ～1.031)]明显大于化疗前后肿瘤密度减小率面积[0.762(95％ CI:0.610 ～0.914)].结论 多层螺旋CT增强扫描肿瘤密度、体积减小率可以帮助评估进展期胃癌化疗的疗效;多层螺旋CT增强扫描肿瘤体积减小率对进展期胃癌化疗疗效的评价优于密度减小率.

目的：探讨多层螺旋CT（ MSCT）增强扫描在胃癌术前TNM分期评估中的价值。方法对78例胃癌患者行MSCT三期增强扫描，以胃癌切除术后病理检查为金标准，对比分析MSCT增强扫描评估胃癌TNM分期的准确性。结果 MSCT增强扫描与术后病理检查一致性较高，T1～T4分期诊断符合率为83．3％；N0～N3诊断符合率为84．6％；M0～M1分期诊断符合率为91．0％。结论 MSCT增强扫描对评估胃癌术前TNM分期有较高的准确性，对胃癌治疗方案的选择有指导作用。

Objective To explore the relationgships between CT signs and the expression of Ki67, p53 in peripheral lung cancer. Methods Sixty-eight patients of peripheral lung cancer who were confirmed by postopera-tive pathology from January 2013 and March 2014 in our hospital were enrolled in the study. All patients under-went 64-slice spiral CT scan or enhanced scan for the CT signs. The expressions of Ki67 and p53 in wax tissue of each patient were detected, and the relationships between CT signs and the expression of Ki67, p53 were explored. Results Patients with spinous protuberant sign had higher proportion of p53 positive expression, with significant correlation (χ2=4.60, P=0.032), and patients with spicular sign had higher proportion of p53 and Ki67 positive ex-pressions (χ2=5.49, P=0.001 9;χ2=4.27, P=0.039). Patients with ground-glass opacity had higher ratio of p53 nega-tive (χ2=8.22, P=0.004), and those with lymph node metastasis signs had higher proportion of p53 positive (χ2=11.2, P=0.001). Patients with signs of lobulation had higher negative expression of Ki67 (χ2=5.56,P=0.018). However, oth-er CT signs showed no significant correlations with the expression of p53 and Ki67. Conclusion The spinous protu-berant sign, spicular sign, ground-glass opacity and lymph node metastasis sign are correlated with the expression of p53 and Ki67, which provides reference for the diagnosis of lung cancer.

Objective To explore the value of multi-slice CT in the diagnosis of solitary fibrous tumor of the pleura (SFTP). Methods The clinical symptoms and CT imaging features of 8 patients clinically and pathologically diagnosed as SFTP were retrospectively analyzed, which were compared with histopathological results. Results All the lesions of the 8 patients were located in dirty pleura. CT-scan showed 6 cases of mass boundary finishing, 1 case of lobulated rim, 1 case of irregular shape, 5 cases of uniform density, and 3 cases with low density area in mass center. Six patients underwent contrast-enhanced CT, of which 4 showed non-uniform reinforcement and 2 showed uniform reinforcement, including 3 cases of tumors with enhancement of blood vessels. Pathological examination showed that the tumor was composed of spindle cells, with a number of arrangements:immunohistochemical Vimentin (+) in 7 cas-es, CD34 (+) in 8 cases, the bcl-2 positive (+) in 8 cases, Sl00 (-) in 7 cases. Conclusion SFTP patients have certain characteristic CT manifestations. CT examination has a certain value for SFTP positioning and the relationship be-tween tumor and surrounding tissue structure.

目的 研究心脉隆对充血性心力衰竭(CHF)患者基质金属蛋白酶9(MMP-9)的影响.方法 选择60例CHF患者,将CHF组患者随机分为二组,心脉隆组(A组)和常规治疗组(B组)各30例,二组患者在治疗前后分别测定血清MMP-9的浓度,并与临床症状的改善及彩色多普勒检测结果进行对照.结果 A组治疗后血清MMP-9水平低于治疗前,二者比较差异有统计学意义(P＜0.05)；治疗后血清MMP-9水平A组低于B组,二者比较差异有统计学意义(P＜0.05)；A组治疗后LVEF、6min步行试验(6MWT)高于治疗前,心率低于治疗前,二者比较差异有统计学意义(P＜0.05).治疗后A组LVEF、6MWT高于B组,心率低于B组,二者比较差异有统计学意义(P＜0.05).结论 心脉隆可降低CHF患者血清MMP-9水平,从而改善左室重构及心脏功能.